Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 15, Issue 3, 2012. Pages: 105-118
Published Online: 1 September 2012

The Effect of the US Medicare Part D Coverage Gaps on Medication Use Among Patients with Depression and Heart Failure

Seo Hyon Baik,¹ Bruce L. Rollman,² Charles F. Reynolds III,³ Judith R. Lave,⁴ Kenneth J. Smith,⁵Yuting Zhang⁶*

¹Phd, Senior Statistician, Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, PA, USA
²MD, MPH, Professor, Department of Medicine, School of Medicine, University of Pittsburgh, PA, USA
³MD, Professor, Department of Psychiatry, School of Medicine and Department of Behavioral and Community Health Science, School of Public Health, University of Pittsburgh, PA, USA
⁴Phd, Professor, Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, PA, USA
⁵MD, MS, Associate professor, Department of Medicine, School of Medicine, University of Pittsburgh, PA, USA
⁶Phd, Assistant professor, Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, PA, USA

* Correspondence to: Yuting Zhang, PhD, Assistant Professor, Department of Health Policy and Management, University of Pittsburgh 130 De Soto Street, Crabtree Hall A664, Pittsburgh, PA 15261, USA.
Tel.: +1-412-383-5340
Fax: +1-412-624-3146
E-mail: ytzhang@pitt.edu

Source of Funding: NIMH RC1 MH088510, AHRQ R01 HS018657, University of Pittsburgh CRDF (Dr.Zhang); P30 MH071944, P30 MH090333, the UPMC Endowment in Geriatric Psychiatry (Dr. Reynolds) The National Institute of Mental Health, Agency for Healthcare Research and Quality, and University of Pittsburgh had no role in the design or conduct of our study, in the analysis and interpretation of our data, or in drafting of this manuscript.

Abstract

We evaluate the effects of Medicare Part D’s coverage gap on drug regimens among beneficiaries with coexisting depression and heart failure (HF), using 2007 pharmacy and medical data for a 5% random sample of Medicare Part D beneficiaries. We compared pre and post gap drug use pattern among three groups: no coverage, generic coverage, and full coverage due to low-income subsidies (LIS). We found that beneficiaries with some drug coverage in the gap were more likely to enter the gap and beneficiaries without drug coverage reduced their use of antidepressants by 5.0% and HF drugs by 9.4% after they entered the coverage gap. Those with generic coverage cut brand-name drugs more than generic drugs but did not shift to generic drugs. However, reduction in number of prescriptions filled for depression and HF was not associated with a significant reduction in medication adherence.

Background: Medication use among Medicare beneficiaries has increased and adherence has improved since the implementation of the Medicare Part D prescription drug benefit in 2006. However, the structure of the benefit, particularly, the coverage gap, is still problematic. It is critical to understand how beneficiaries with coexisting conditions respond to the coverage gap and whether their response differs by type of medications.

Aims of the Study: The paper aims to evaluate the effects of Medicare Part D's coverage gap on drug regimens among beneficiaries with coexisting depression and heart failure (HF).

Methods: Drug utilization patterns and medication adherence of a 5% random sample of Medicare Part D beneficiaries with depression and HF in 2007 were observed. Drug utilization patterns were measured on the basis of reported drug claims and medication adherence was defined as the proportion of days of medication possession in a given period. We compared pre-post drug use patterns and medication adherence across three groups: no coverage, generic coverage, and full coverage due to low-income subsidies (LIS) and used propensity score weighting to adjust for difference across groups.

Results: Beneficiaries with some drug coverage in the gap were more likely to enter the gap: 82% for LIS, 79% for generic-only and 58% for no coverage. Beneficiaries without drug coverage reduced their use of antidepressants by 5.0% (95% CI 1.7%-8.2%), and HF drugs by 9.4% (95% CI 7.2%-11.5%) after they entered the coverage gap. Those with generic coverage cut their brand-name drugs more than generic drugs but did not shift to generic drugs. However, adherence to antidepressants did not change; adherence to HF drugs reduced slightly, 2.5% (95% CI 1.2%-3.7%) in the no-coverage group and 2.6% (95% CI 1.3%-3.9%) in the generic-coverage group.

Conclusions: The coverage gap was associated with a modest reduction in number of prescriptions filled for depression and HF but it was not associated with a significant effect on adherence.

Implications for Health Policy: We found that beneficiaries with coexisting depression and HF were less likely to reduce their drug use than beneficiaries in general. In addition, the gap was not associated with a large reduction in adherence. It suggests that concerns about the coverage gap's harmful effects on medication adherence, or comorbidities might be overstated.

Implications for Further Research: Further studies on how people make medication use decisions in the face of changes in benefits and how the coverage affects non-drug medical outcomes are warranted.

Received 6 April 2012: accepted 6 July 2012